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General NPI Number Information
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NPI Number | 1265072615
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Entity Type | Individual
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Provider Name | GRETCHEN RENFRO MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1500 EISENHOWER LN STE 900
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City | LISLE
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State | IL
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Zip | 60532-2135
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Country | US
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Telephone | 630-428-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 1637 TULANE DR
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City | NAPERVILLE
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State | IL
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Zip | 60565-1736
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Country | US
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Telephone | 630-222-3639
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149006216
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License Number State | IL
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